By Clare Absher RN, BSN Updated: 01/17/2019
Photo by NeONBRAND on Unsplash
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By 2020 there will be over 56 million Americans aged 65 and older. 1
70% of all adults aged 65+ will need assistance at some point. 2
40% of adults aged 65+ will need assistance on a daily basis. 3
From 2016 to 2017, the annual median cost of long-term care services increased an average of 4.5 percent; this equates to almost three times the rate of inflation in the United States! 4 As we approach the end of 2018, the Genworth Annual National Median Costs for home care are staggering: 5
| National Costs | Monthly |
| Home health aide | $4,195 monthly |
| Homemaker services | $4,004 monthly |
Private pay or self-pay for home care services is the most widely accepted form of payment due to no other available reimbursement sources. It simply means that services are contracted by an individual or family based on their preferences and paid for out of pocket. Most home care services that are needed to assist with activities of daily living are considered non-skilled care. Medicare and other private health insurances will not reimburse for non-skilled home care services leaving private pay as the only payment option.
Older adults privately pay caregivers to help with:
Hiring caregivers through reputable licensed agencies may enable an elderly person to age in place safely at home.
Long Term Care Insurance will cover most home care services that are provided by licensed home care agencies, but policies vary greatly on amount of and extent of coverage depending on your specific plan. Most policies reimburse for skilled nursing and rehab services in addition to custodial care for help with activities of daily living such as personal care, meal preparation and medication reminders. In addition to home care and nursing homes, some policies cover adult day care and respite care to give families a break from caregiver duties. More about Long Term Care Insurance.
Medicare will pay for limited home care when the patient requires skilled services such as Nursing, Physical Therapy, Occupational Therapy or Speech Therapy and is considered home bound. The focus of Medicare home health services is rehabilitation and is short-term often for a few weeks following a hospitalization or discharge from another acute care facility. Skilled care visits are covered by Medicare when scheduled by the health care professional on an intermittent basis under the direction of a physician.
On the contrary, home care scheduled for blocks or periods of time to help with daily activities including personal care, meal preparation, medications, ambulation, housekeeping, transportation and companionship are not covered by Medicare. These private duty types of custodial services provided by nurse assistants, homemakers and companions are not skilled and therefore not reimbursed through Medicare.
Medicaid will cover home care services with limitations that vary from state to state. Medicaid reimburses for home care services through what are known as Home and Community-Based Services (HCBS) "waiver" programs. Eligibility for the Medicaid waiver programs are twofold based on financial requirements and the need for care. The need for care must be extensive enough that without in-home services, he or she would have to move into a nursing home.
HCBS waiver programs may provide skilled care similar to Medicare, but unlike Medicare, they may also provide personal care services to help with activities of daily living such as eating, bathing and dressing. Medicaid recipients can also get help with homemaker, transportation, meal delivery and adult daycare services.
The Veteran Aid and Attendance benefit provides money to those who need assistance performing everyday tasks. This extra monthly pension is used to cover the costs of in-home care. Usually financial restrictions apply, however, many can qualify when they have large medical expenses for which they do not receive reimbursement. Aid and Attendance benefits are available to veterans who served at least 90 days, with at least one day during wartime. The veteran does not have to have service-related disabilities to qualify and surviving spouses are eligible. Caregivers must be needed to assist veterans at home with activities of daily living such as bathing, feeding, and dressing and also individuals who are bedridden, blind, or residing in a nursing home.
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Clare Absher is a Registered Nurse with 44 years of experience. Most of her experience is in home health serving as a caregiver, educator, patient advocate, and liaison between families and community resources. She has also worked in acute care, assisted living, and retirement settings. She is passionate about helping families care for their elderly loved ones at home.
